Saturday, October 4, 2014

Ebola: High Touch High Tech Failure

Whenever new technology is introduced into society, there must be a countervailing human response – that is, high touch – or the technology is rejected . The more high tech, the more high touch.

John Naisbitt, Megatrends, 1982

The handling of the Ebola problem in Dallas – with the exposure of 100 or so people to a Liberian patient with Ebola – has been a communications and political fiasco.

Here is Politico’s take on the matter (Arthur Allen, “Did a computer Raise Ebola Risk,” October 3, 2014).

“Communication is at the heart of the problem described by Texas Health Presbyterian Hospital. In its statement Friday night, the hospital said that “as a standard part of the nursing process, the patient’s travel history was documented and available to the full care team in the electronic health record (EHR) including within the physician’s workflow.”

But the physician may not have seen the nurse's travel history e-note. Whatever the reason, the nurse and the doctor did not communicate.

Now the hospital says it may have had a “flaw” in its electronic medical record system. A nurse documented that Thomas Eric Duncan was from Liberia and sought to alert the doctor though the EMR. But alas, Duncan’s travel history “ may not had automatically appeared in the doctor’s EMR “window.

But then the hospital contradicted itself and say there was no “flaw.”

Flaw or no flaw, red flag or no red flag, the doctor failed to act and sent the patient packing on an antibiotic, with the patient only to return several days later with full-blown Ebola.

There was another communication failure as well. Just before the start of his journey to America, the patient had carried a woman dying of Ebola to her home. Apparently airline authorities either failed to ask him about his exposure to Ebola, or the patient failed to communicate that exposure.

Finally, Dr. Thomas Frieden, the head of CDC in Atlanta, perhaps unaware of these events, ensured the world that all was well, and the patient posed no risk of spreading the virus, even though at one time or another, he had been in close contact, either on the flight to America or his activities in Dallas, with as many as 100 people. Dr. Frieden said only symptomatic patients could spread the disease, and then only by direct touch or exposure to body fluids – urine, blood, or vomitus.

But the main culprit may not have been the hospital staff, Dallas health officials, or Dr. Friedman. It may have been the electronic medical system.

Ever since the federal government , in concert with ObamaCare, invested $ billion in electronic records and made the records a priority a principle means of improving health care and lowering costs, physicians have had trouble with EMRs.

The problems are legion.

EMRs are a heavy expense, not only in installing but in maintaining and training staff.

EMRs slow “productivity,” meaning they may slow the number of patients seen by as much as 30%, at least in the initial stages of use.

EMRs distract from patient contact, being frequently interposed between the patient and doctor, during the history taking and examining process.

EMRs take the doctors’ time in entering the data and making sure payment codes are correct.

Because EMRs are long on streams of data and short on narrative, they tend to be misread or ignored and may not communicate the patient’s true story.

Many EMRs do not communicate with other EMRs, even in the same institution , such as between nurse and doctors, between the ER and the patient floors, and between doctor EMRs and hospital .

With Ebola, a high-touch disease got loose in the high-tech forest.

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